Republic of the Philippines)

City of Taguig ) S.S.

_____________________________________________________________________

AFFIDAVIT
I DR. ANNABELLE V. BRIONES , of legal age, Filipino citizen, currently working at
Industrial Technology Development Institute (ITDI) as Director with office address at Metrology
Building, DOST Compound, General Santos Avenue, Bicutan Taguig City, Philippines with telephone
no. 837-20-71, after having sworn in according with law, do hereby depose and say THAT:

1. That, ITDI, an attached agency of the Department of Science and Technology (DOST),
duly organized and existing under and by virtue of the laws of the Republic of the
Philippines;

2. That, the shipment of following reference standards with details below are due for
calibration;
Item: Gauge Blocks (Grade K) Item: Gauge Blocks (Grade K)
Nominal Value: 0.5 mm to 100 mm (122 pieces) Nominal Value: 0.5 mm to 100 mm (11 pieces)
Brand: Mitutoyo Brand: Mitutoyo
Serial Number: 1704909 Serial Number: 1805268

3. That, the said shipment shall be temporarily exported to Thailand and will be returning to
the Philippines after calibration;

4. That, the supporting import documents cannot be found;

5. That, the shipment is not under bond and that duties and taxes has been paid during
importation;

6. I am executing this affidavit in order to attest to the veracity of the foregoing declarations
to the best of my knowledge and belief, to inform BOC of the fact of such loss to prevent
its unauthorized use and in support with our customer requirements.

IN WITNESS WHEREOFF, I have hereunto placed my hand and affix my signature this
__________________ at City of Taguig.

ANNABELLE V. BRIONES, Ph. D.

Affiant

SUBSCRIBED AND SWORN TO before me this _______ day of

______________________, 2020, affiant having exhibited to me his /her Passport No. S0010495A
issued at DFA Manila on 06 October 2017 valid until 05 October 2022.

Doc. No. _______________

Page No. _______________
Book No. _______________
Series of _______________